title: The use of continuous ambulatory peritoneal dialysis for patients with end-stage renal disease and pre-existing advanced liver disease.
abstract: End-stage renal disease (ESRD) associated with pre-existing advanced liver disease (ALD) has increased the risk of morbidity and mortality. The aim of this study is to assess the outcome following the use of continuous ambulatory peritoneal dialysis (CAPD) in ESRD patients with ALD. A retrospective case-controlled study was performed on 16 patients with ALD and ESRD (ESRD-ALD) and 27 control patients with ESRD but without liver disease (ESRD); both groups were started on CAPD during the same period. No major complications were observed in either group in the immediate post-surgical period and, after an average break in period of 11.3 days, the cases and controls were started on regular CAPD. The average duration of follow-up was 8 ± 2.3 months in the ESRD-ALD group compared with 20 ± 1.3 months in the ESRD group. The overall peritonitis rates were 1.26/treatment year in the ESRD-ALD group and 0.63 in the ESRD group. The 6- and 12-month survivals among ESRD-ALD patients were 63.75% and 38.75%, respectively. Patients with ESRD-ALD had significantly lower baseline serum protein and albumin levels at the time of initiation of CAPD. On follow-up, the hemoglobin levels improved in both the groups along with an improvement in the serum protein and albumin levels. Fourteen of the 16 ESRD-ALD patients died at the end of the 3-year follow-up period; deaths were due to terminal liver failure in nine patients and peritonitis in five patients. Patients who died in the ESRD-ALD group had lower serum albumin, lower body mass index (BMI) (median BMI 18.2 vs. 25.6) and higher grades of liver disease [child Pugh grade B (8), grade C (6) vs. grade B (2)] at initiation of CAPD. Our study suggests that CAPD is a safe modality in patients with ESRD-ALD and that it does not carry any major risk for bleeding tendencies, technique failure or worsening of nutritional status. Low serum albumin, lower BMI and higher grade of liver disease at initiation are associated with higher mortality in these patients.
authors.affiliation: Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. anupmaneph@gmail.com
authors.forename: Anupma
authors.initials: A
authors.lastname: Kaul
authors.forename: R K
authors.initials: RK
authors.lastname: Sharma
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.forename: Narayan
authors.initials: N
authors.lastname: Prasad
mesh_terms: D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008107:Liver Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D012189:Retrospective Studies